Galen Healthcare Solutions: Allscripts Consultants Enterprise EHR

Recently, the Centers for Medicare and Medicaid Services issued the final rule concerning meaningful use of electronic health records looking to qualify for the government incentives intended to increase the implementation of EHRs in the American healthcare system. A collective sigh of relief could be heard in offices of organizations around the country who have been scrambling to try to develop a game plan to meet the requirements outlined in the interim final draft. The final rule was drafted with an eye towards concerns that the requirements in the interim final rule were unattainable. By breaking the requirements down into two sets, a “Core” set of 15 items that all must be implemented, and another “Menu” set of 10 additional items of which only 5 need to be implemented between 2011-2012, CMS has made the process of meeting the requirements appear attainable. The final rule presented by CMS provides a more manageable framework for implementation of the technologies and actually may provide an opportunity for the organizations implementing the electronic health records to get some meaningful use out of the this legislation.

Tags: Allscripts Enterprise EHR, EHR, Meaningful Use

We here at Galen have seen a greater influx of requests to be able to integrate client’s EHR environments with 3rd party applications and/or internet websites.

I’ve created a few examples that I’ve added to our Wiki page.

1. http://wiki.galenhealthcare.com/Patient_Portal_Integration

With this case study Galen had a client who has implemented a patient portal application whereby patients are able to send messages to their doctors regarding tests, results and general questions. The client was looking for a way to have the provider be able to integrate this application directly into the EHR. With RelayHealth’s help we have succesfully built a prototype whereby a provider can seamlessly communicate with a patient in the most efficient manner possible!

2. http://wiki.galenhealthcare.com/images/5/57/Add_new_Web_framework_documents_to_the_EHR.pdf

In this example a client was looking for a new link on their vertical toolbar which would allow them to display any website in their current workspace (the main viewing pane of the EHR). This one example integrates the website directly into the EHR window without having to navigate through a new tab or window, showing a FRAX calculator. The other tab actually has the ability to take in patient context (height, weight, blood pressure, etc.) and pass it into a form automatically populating fields to save physicians valuable time. This article goes through the steps involved in setting up new vertical toolbars, horizontal toolbars, and workspaces to set up these outside websites in the EHR. The actual code to populate patient context is fairly complex but definitely something Galen would love to help out with!

Tags: Allscripts, EHR, EHR Implementation, HL7, Integration, Successful EHR Implementation, Technical

According to an article in Health Data Management, e-prescribing providers will now be able to use e-prescribing for controlled substances (about 20% of all scripts sent). A key piece of the article says, “The rule will permit pharmacies to receive, dispense and archive electronic prescriptions for controlled substances.”

This is a long overdue ruling, and much necessary. It is crazy to think that a paper process was safer (and offered more security) than e-prescribing could. A link to the article is offered below.

http://www.healthdatamanagement.com/news/controlled_substances_e-prescribing_rule_dea-39995-1.html

Tags: E-prescribing, EHR, electronic RX

Business Need/Problem Statement

Some of our clients have recently expressed the desire for a limited, read-only view in to the AE-EHR to extend access to audit entities. For instance, the requirements of one organization included a limited patient-access read-only environment to be in compliance with FDA Research Part 11 restrictions for clinical trials. Another organization needed it for insurance audit purposes. And still again, others desired to provide an extended environment to allow hospitalists, ED physicians, and critical care physicians access to selective patient charts.

Approach

One of the more popular approaches has been to segment out a separate read-only organization in the Allscripts Enterprise Electronic Health Record (AE-EHR). The AE-EHR handles organizations quite nicely and facilitates an approach of segmenting out entities – the following Galen Wiki article covers a scripted means of deploying a new organization in v10 AE-EHR.

Once the organization has been created, patients can then be “bulk-loaded” to the organization via SQL scripts. New AE-EHR users can then be created and associated to this organization. Finally, to setup the read-only portion, security gates can be implemented.

Extendability

An additional requirement of one of our clients included an approach that offered the capability to dynamically add/remove patients to the “Audit” organization real-time. We facilitated this via creation of a file-based interface from ConnectR to the AE-EHR. The interface accepted its input from a well defined flat-file (comma-delimited, including MRN, Action – Add or Remove, and OrganizationID) and utilized that data to add/remove patients to the org via a custom stored procedures – the de facto application programming interface (API) to the AE-EHR clinical database.

And still further, another client requested that the audit/read-only entities (users of the system) be granted the ability to create tasks . For example, the client desired a specific, high priority task, identifiable as originating from the audit/read-only entity – in this case hospitalists which could be assigned to the patient’s PCP. In this case, the clients’ hospitalists could communicate high priority continuity of care tasks, which require prompt reaction, to the PCP at discharge. However, the PCPs should not be able to task back to the hospitalists, and this can be achieved by setting the EnableOrgFilterFlag preference in the AE-EHR.

If your organization needs assistance in setting up a audit environment to provide limited, read-only access to the AE-EHR, please contact sales@galenhealthcare.com and visit our website for more information regarding our technical and professional service offerings.

Tags: Allscripts Enterprise EHR, EHR, EHR Implementation, Extendability, Interfaces, Read-Only, Tasking

Galen will be hosting another in Enterprise reporting workshop this coming March.  This has been a popular course, so please sign up early!

What: A three-day course for report writers, DBAs and those in healthcare informatics on the Allscripts Enterprise EHR database.
When: March 1 – 3, 2010
Where: Boston, MA
Price: $2,500

The Galen Database Architecture and Reporting Workshop has furthered our understanding of the Allscripts Enterprise EHR database.  The clear presentation and substantial hands-on time helped us to greatly accelerate our production of customized reports.  And, the data dictionary documentation alone is invaluable.
– Chris Hyde, DBA, Albuquerque Health Partners

The attached announcement includes additional information regarding the course and suggested audience (report writers, DBAs, etc).

Please contact Mike Dow to register, or if you have any questions – mike.dow@galenhealthcare.com

Tags: Allscripts Enterprise EHR, Crystal Reports, Custom Reports, Database, EHR, Reporting, SQL Server

There is quite a bit of buzz in the healthcare IT community surrounding the ONCHIT/CMS release of the Meaningful Use Interim Final Rule and the  and the EHR certification requirements. The author of HISTalk kindly spent his New Year’s Eve poring over the documents to provide an excel worksheet summary of the actual criteria and thresholds and the author of the Medical Software Advice blog did a great job of outlining definition, features and measurement with his blog entry.  I thought I would take it a step further and provide some meaningful information to CFOs and PMs by taking a stab at quantifying the effort involved with each measure. First some background information and disclaimers:

• This estimated effort is based on 50 physician multi-specialty organization.
• It is intended to give a ballpark of effort involved and the numbers serve as estimates only.
• It does not necessarily scale linearly with number of providers or specialties.
• The effort only addresses four categories of effort – implementation, technical, interface and training.
• Categories of effort not addressed include project management, systems configuration and deployment, networking configuration and deployment, hardware (including desktop) deployment, and helpdesk and on-going support.

The meaningful use matrix with effort broken-out can be found on the Galen Healthcare Solutions Wiki.

Now that we have presented the effort involved, let’s delve into how EHR deployments – specifically  AE-EHR deployements – are typically phased:

Phase I: Base, Document, Scan and Dictate

Description: Provide a baseline level of EHR functionality to all users. Real-time access to physician schedules, transcribed and scanned documents, facilitation of dictation.  Data conversions, Scanned charts and documents, Base Deployment. This approach typically appeals to all providers regardless of technical aptitude and would not require significant workflow changes

Advantages: Clinical information access internal and external to the clinic, reduced level of change for physicians through the use of dictate, realized benefits of decreased errors and re-work.

Interfaces:

• Registration & Scheduling
  • Real-time inbound registration and scheduling feed from practice management system.
  • Initial bulk-load of existing active patients and appointments
• Transcription
  • Real-time inbound transcription interface from transcription system.

*Phase II: Rx+, Note, Forms, Results

Description: Add medication management, structured note and results

Advantages: Ability to collect structured information facilitating use of panel queries. Additionally, formulary compliance, and prescription faxing/e-prescribing to pharmacies and ability to capture results as discrete data elements

Interfaces:

• Results
  • Real-time inbound results interface from lab system.

*Phase III: Order, Charge

Description: Facilitates charge capture and order transmission.

Advantages: Completes the access to centralized patient data and further enhances the quality of care and service to patients.

Interfaces:

• Orders
  • Real-time outbound order interface to lab system
• Charge
  • Real-time outbound charge interface to the practice management system.

*Phase II and III can be combined based upon the organization requirements

In conclusion, one of the biggest questions that lingers for me is how the data is to be relayed to the government such that organizations can be evaluated as to whether or not they meet the thresholds to receive the incentives. Custom reporting comes to mind as precedent has been set here, specifically with PQRI and Medicare HCC. Galen Healthcare Solutions certainly can provide custom reporting specific to organizations needs in order to communicate meaningful use. Another solution is Allscripts Clinical Quality Solution powered by TeamPraxis. In the meantime, we wait for the rule to be finalized and anticipate announcement of how the meaningful use data is to be relayed.

If your organization is looking for assistance in exhibiting meaningful use, please contact sales@galenhealthcare.com and visit our website for more information regarding our technical and professional service offerings.

Tags: Allscripts Consultants, Allscripts Enterprise EHR, Custom Reports, EHR, EHR Certification, EHR Implementation, Integration, Interfaces, Meaningful Use, Meaningful Use Matrix, Reporting, Successful EHR Implementation

A recent engagement with a large multi-specialty client gave some insight into increasing physician acceptance and adoption of the Electronic Health Record. It became apparent very early on during the rollout of ePrescribe and Call Processing, that easier accessibility equals higher acceptance. The physicians want to be able to access the EHR instantaneously while with the patient: order medications, input visit data, submit charges. This proved to be a difficult task when workstations were not available in the exam rooms. We discovered that the providers were less likely to exit the exam room at the end of the patient visit to print/send prescriptions and return to the exam room with the patient.

There are different options available to increase accessibility. Permanent workstations in each exam room provide the providers with the ability to access the EHR directly from the exam room and complete any tasks needed for the current visit: order medications, diagnostic tests, submit charges, input visit data. Tablet PCs give the provider the flexibility of moving around the clinic and working in different areas. They are able to access the EHR while in the exam room, in their office, or standing at the nursing station.

I have seen the use of both the Permanent workstations and Tablet PCs in different sized organizations. They are both viable options that depend on the needs and infrastructure of the organization.

Tags: Allscripts Consultants, EHR, EHR Implementation, MSO

The benefits of Health Information Exchanges (HIEs) are quite profound. Recently we were able to assist one of our clients in exchanging data  from the Electronic Healthcare Record (EHR) with their state’s HIE network – specifically registrations, radiology results and documents. The biggest challenges we faced in integrating the EHR and the HIE included the following:

• Patient identifiers – these can be different between driving system (Radiology Information System (RIS), Laboratory Information System (LIS), and EHR. Consistency with the Master Patient Index (MPI) across all interfaces is the desired outcome.
• Filtering – mental health document types, “celebrity patients,” preliminary documents, unverified results – the list goes on and on. Knowing the gamut of different options of configurability is helpful in deciding which filtering should take place.

These interfaces were built in the ConnectR interface engine utilizing the existing Application Programming Interface (API) to the Allscripts Enterprise EHR (AE-EHR) – inbound and outbound stored procedures. It should be noted that the ConnectR interface engine is used as the standard interface engine by Allscripts to facilitate the communication between healthcare systems, however there are alternatives.

This approach is not entirely desirable in that it requires customization of the interfaces to the particular vendor/client based upon their underlying data exchange implementation architecture. In an ideal sense, the data exchange would facilitate a “seamless” plug-in to existing AE-EHR users and HIEs. This is certainly what the industry is driving towards.

As Dr. Halamka alluded to in his blog posting yesterday, the ideal scenario is one in which CDA/CCD documents are used to exchange data between the EHR and the HIE as they offer a complete set of the patient record. HITSP (Health Information Technology Standards Panel) standards describe these transactions  as there are thirteen original Interoperability Specifications (IS) into an EHR-centric view to facilitate alignment with Health Information Technology provisions of the American Recovery and Reinvestment Act of 2009 (ARRA). For more information regarding Health Information Exchanges (HIEs) and “real-world” implementations and their utilization of HITSP products see the following HIMSS webinar. In the interim, for those Allscripts clients looking to get ahead of the game with meaningful use, we are left to develop interfaces within the framework of the existing API to/from the AE-EHR.

In closing, be very aware of the possibilities as the HIE landscape is changing. For example, Navinet now offers subsidization of HIE implementation costs. However, the challenge remains in determining the best business model to fund the exchange going forward.

For additional information regarding Galen Healthcare Solutions’ data exchange / interface services please contact justin.campbell@galenhealthcare.com or visit www.galenhealthcare.com/interface-service

Tags: EHR, HL7, Integration, Interfaces

The benefits of a results data exchange between a vendor system and the Electronic Healthcare Record (EHR) are profound, as the need for redundant and often erroneous data is greatly reduced. More importantly, by implementing a results data exchange to the EHR, providers are delivered more timely and accurate clinical data, yielding an increased level of patient care.

Benefits

• Elimination of redundant entry of patient data.
• Result reconciled to order automatically
• Immediate availability of the results to the enterprise.
• Decreased risk of patient matching errors (name misspellings, missing dates of birth, etc).
• Elimination of scanning of signed paper labs to the EHR.
• No more lost lab results.
• Run reporting on the data from labs in EHR (for example, blood sugar change over time).
• Automated result tasking as well as the ability to send copies to related providers, such as the referring provider or the patient’s primary care provider.
• Automated Tasking.
  • Verify result task.
  • Carbon Copy (Review result task).

  

• Automated synchronization of item dictionary.
• Drop a charge automatically to the PMS (assuming a charge data exchange is in place).
• Capability to automatically send insurance information to labs for lab direct client bill (assuming the insurance data exists in the EHR. This data is usually fed from a separate PMS data exchange).
• For PACs data exchanges, facilitates viewing of image result directly from EHR.
  

And perhaps the biggest benefit is that many groups are able to negotiate with their lab and radiology providers to subsidize the cost of the data exchange. Since the data exchange presents many benefits from their point-of-view, the lab and radiology providers are often happy to provide financial incentive for practices to participate in an electronic data exchange.

Return on Investment (ROI)

A three-hospital study conducted by LINK Medical and Philips Medical provides great insight into the return on investment that interfacing can provide. These hospitals analyzed and assessed the effectiveness of automating the process of Electrocardiogram (ECG) orders and test results, with the following realized outcomes:

• Reduction in direct annual labor costs ($11–25,000).
• Elimination of non-billable tests.
• Elimination of lost charges (1% to 2% of ordered tests).
• Short payback period (less than 12 months).
• On-going ROI – these savings and associated benefits continued.

Overall cost savings were in the range of $43,000 to $59,000 per annum.

Galen Healthcare Solutions: Interface Services

Tags: Custom Reports, EHR, Integration, Interfaces, Results Interface, Technical

WellSpan Health has just made the move from Allscripts Enterprise EHR’s version 10 to V11. It’s Go-Live Monday and it’s quiet in the command center. How did we get here? 400 Doctors, 1900 total end users, 4 external MSO sites and 60 internal sites up on the EHR, and close to 40 of them completely paperless. 1pm on Go-Live Monday and we have had 125 calls. That is less than 1% of end users calling in with anything. The calls that we are receiving are typical of any go live. Some PCs were had issues with the Allscripts (ActiveX) controls and end users still learning their way around in a new system. We have entered one support ticket into the vendor. What are the elements that led to this success?

The Client Team

The client team at WellSpan Health is deep, and knowledgeable. They take pride in partnering with their physicians, and the physician partners drive the design of the EHR. The physician champions have been intimately involved in the project from classroom training to Go-Live. Their schedules have been adjusted throughout the course of the project to be able to provide clinical oversight to the build process and to act as liaisons with the leadership team internally with the organization. The build and configure team is made up of multiple analysts, three lead analysts and two physician champions. Some of these team members typically work with other products or in specific areas (with Dragon Dictate, with the practice management system, Allscripts Scan, etc.) but have been brought in to meet the staffing needs of the project. All of the people that worked on the build and configuration, as well as the technical staff and the desktop team have been working in conjunction with each other through the entire process.

Testing

The testing of the system was diligent and thorough. There was one person on the team who was a designated testing coordinator. Testers worked through every workflow used in the organization multiple times. The physician champions worked through their workflows and ensured that they had a through understanding of the system and were prepared to discuss the system and provide support to their colleagues. Their testing plan included 16 people working full days in a lab, hammering on the system. They paced their testing with internal issue resolution – they would complete one week of testing and follow it with one week of internal issue resolution, and then test again. They continued this pattern for 6 weeks. This testing plan allowed for their team to become intimately familiar with the new features of the application and clearly validate their build decisions.

End User Training

End user training lasted for a month prior to go-live and provided many options for learning for individuals with different learning styles. There was introductory information available online and a very clear and valuable webcast for end users designed by the client team. Classroom sessions in a lab were offered in 2 hour session and 4 hour sessions by the education team. The client also created a Citrix training environment where end users could log in and practice prior to the V11 deployment. The week before Go-Live, the education team offered V11 Workshops.

Deployment

The Command Center is fully staffed with help desk staff, analysts, the project manager, desktop team along with the Upgrade Consultant and Upgrade PM. Over the course of the weekend there was a dial-in number that administrators could call into to check the process of the upgrade. There is a three tiered issue resolution process in place and as of 2pm on Go-live Monday, only one issue has not been able to be resolved on-site and been logged into the vendor. In addition to the issue resolution process in place, the physician champions are available today to go directly to practices where physicians would be better served by talking to another physician about the workflow and the presentation of the system.

The client knew that even with the thorough education provided, there would be a learning curve for their end users on the initial days logging into the new system. Provider schedules have been reduced for the week of go-live in order to support the end users and to give them time to adjust to their new navigation and adjustments to workflow.

WellSpan Health is live on V11, end users are in and practicing medicine…and it’s quiet here in the command center. While I am normally a person who thrives on a sense of urgency and loves solving problems – I am glad that today is quiet; it means my client has done a really excellent job.

For additional information regarding Galen Healthcare Solutions’ upgrade / professional services please contact max.henson-stroud@galenhealthcare.com or visit www.galenhealthcare.com/touchworks

Tags: Allscripts Enterprise EHR, EHR, MSO, v11